This project focuses on a set of local processes -including interpretation, contestation, and adaptation- with which physicians manage the implementation of the electronic health record (EHR) system, a significant organizational change propelled by broader institutional changes and logics. EHR implementation is a cultural and technological shift that requires physicians and healthcare providers to restructure daily routines and reorient workplace interactions, under the auspices of higher-level logics and policies that may be at odds. Despite the push for a nationwide, networked electronic records system, there has yet to be a systematic inquiry into the experience of professionals on the frontlines of healthcare. Little headway has been made into understanding how clinicians navigate the shift from a traditional system to an electronic system, and how this shift may impact not only the overall implementation process but the broader institutional logics that underlie and often justify the change. This study examines: 1) How physicians and other healthcare workers make sense of changes in routines and standard operating procedures with respect to EHR implementation, within the context of broader institutional logics; 2) how physicians manage conflict and contestation that arises around EHR implementation and what the costs of these conflicts are for the organization; and 3) the roles professional power, practice, and identity play in EHR implementation. This dissertation uses an ethnographic approach for exploring the dynamics between institutional logics and local practices. The candidate will conduct a multi-method case study of a networked medical group located in Northern California which will begin implementing an EHR system in late 2008. Methods will include long-term participant observation of physicians and healthcare workers, support staff, managers and IT technicians; in-depth, semi-structured interviews; organizational surveys; and institutional data. This medical group represents a key research site because it is transitioning from a traditional paper-based system to an EHR system and will allow for a 3before-and-after4 design to examine adaptation dynamics. This research will provide empirical insight into the challenges and impacts of EHR implementation on the frontlines of health care, beyond the technological and legal challenges, during the course of actual clinical practice. When clinicians are impacted, the delivery of healthcare is impacted, which ultimately affects patients. As such, this research may enable policymakers and professionals to create best practices and guidelines with respect to EHR implementation, allowing EHR implementation to unfold effectively as possible and reducing negative impact on the delivery of healthcare and the quality of services offered to patients. Creating and supporting such best practices is relevant to AHRQ, given the agency6s emphasis on clinical practice, technology assessment, and effectiveness of care. [unreadable] [unreadable] Public Health Relevance: The Physician Experience of EHR System Implementation--Project Narrative--This project studies the impact of the implementation of an electronic health record (EHR) system on physicians. By examining how physicians experience this organizational change that affects a significant professional routine, this research hopes to determine the process by which these individuals manage and adapt to the new system. The end goal is to use this data as a basis for developing a system of best practices to aid in future EHR system implementations nationwide. [unreadable] [unreadable] [unreadable]